What is Zeposia? Uses, warnings & side effects

Zeposia is titrated slowly over the first week of therapy. The recommended starting dose of Zeposia is 0.23 mg by mouth once daily on days 1 through 4, then 0.46 mg by mouth once daily on days 5 through 7, and finally 0.92 mg by mouth once daily on day 8 and thereafter. 

Zeposia capsules should be swallowed whole and can be taken with or without food.

If you miss a dose of Zeposia, take it as soon as you remember. However, if it’s close to the time of your next dose, do not double up doses to make up for the missed dose. Take the next scheduled dose and resume daily doses. 

Abruptly stopping Zeposia, more than just a dose or two, may be associated with rebound MS in some MS patients; completely stopping this medication should always be done under the supervision of a medical professional.

Zeposia is not right for everyone. This medication should not be used in individuals with a recent history (within the past 6 months) of myocardial infarction, unstable angina, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, or class III/IV heart failure. In individuals with certain types of atrioventricular heart block, sick sinus syndrome, or sinoatrial block. Zeposia should also be avoided unless the individual has a functional pacemaker. 

Zeposia is contraindicated in those with severe untreated sleep apnea, given the risk of reduced pulmonary function while on therapy, and those taking monoamine oxidase inhibitors, given the additive risk of dangerously high blood pressure.

This medicine increases the risk of infection by suppressing the immune system. Initiation should be postponed in patients with active infections, and patients should be tested for immunity to varicella zoster virus (VZV) if they do not have a history of varicella (chickenpox) or have not received a full vaccine regimen against VZV. 

Given the immune suppression associated with Zeposia, live-attenuated vaccines should be administered at least one month prior to Zeposia administration. Such vaccines should be avoided during treatment and held until 3 months after completion of the medication.

Zeposia should be avoided in patients with a significant cardiac history, including those with certain arrhythmias requiring treatment with certain medications, ischemic heart disease, heart failure, uncontrolled hypertension, and a recent history of myocardial infarction, among other conditions. Patients with a cardiac history should be reviewed by a cardiologist to evaluate the appropriateness of receiving Zeposia. 

Zeposia is not recommended in patients with liver disease.

This medication is associated with an increased risk of cancer, including rectal adenocarcinoma and malignant neoplasm of the breast, but particularly basal cell carcinoma of the skin and malignant melanoma. Limiting exposure to sunlight, wearing protective clothing, and applying regular sunscreen with a high sun protection factor (SPF) is important while on Zeposia.

Zeposia can lower your immune system, so it should be spaced out from live vaccines.

Zeposia should not be taken cautiously with other medications that may suppress the immune system, and ideally, concomitant use should be avoided altogether. The immune system should recover within 3 months after stopping Zeposia. 

Some medications can affect how Zeposia works or can increase the side effects associated with its use. Tell your doctor if you are taking any of the following: MAOIs, CYP2C8 inhibitors or inducers, breast cancer resistance (BRCP) inhibitors, any medication that can increase serotonin or norepinephrine (e.g., opioids, SSRIs, or SNRIs). Zeposia should also not be taken with QT-prolonging medications or medications that slow the heart rate, such as beta-blockers.